Feasibility and efficacy of bypassing the right ventricle and pulmonary circulation to treat right ventricular failure: an experimental study

<p>Abstract</p> <p>Background</p> <p>Right ventricular failure (RVF) and -support is associated with poor results. We aimed for a new approach of right - sided assistance bypassing the right ventricle and pulmonary circulation in order to better decompress the right ventricle and optimize left ventricular filling.</p> <p>Methods</p> <p>From a microaxial pump (Abiomed), a low resistance oxygenator (Maquet and Novalung) and two cannulas (28 and 27 Fr) a system was set up and evaluated in an ovine model (n = 7). Connection with the heart was the right and left atrium. One hour the system was operated without RVF and turned of again. Then a RVF was induced and the course with the system running was evaluated. Complete hemodynamic monitoring was performed as well as echocardiography, flow measurement and blood gas analysis.</p> <p>Results</p> <p>The overall performance of the system was reliable. Without RVF no relevant changes of hemodynamics occurred; blood gases were supra normal. In RVF a cardiogenic shock developed (MAP 35 ± 13 mmHg, CO 1,1 ± 0,7 l/min). Immediately after starting the system the circulation normalized (significant increase of MAP to 85 ± 13 mmHg, of CO to 4,5 ± 1,9). Echocardiography also revealed right ventricular recovery. After stopping the system, RVF returned.</p> <p>Conclusions</p> <p>Bypassing the right ventricle and pulmonary circulation with an oxygenating assist device, which may offer the advantages of enhanced right ventricular decompression and augmented left atrial filling, is feasible and effective in the treatment of acute RVF. Long time experiments are needed.</p

Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review.

BACKGROUND: Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation. MATERIALS AND METHODS: We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients. RESULTS: The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%). DISCUSSION: Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%

Fusion models for generalized classification of multi-axial human movement: validation in sport performance

We introduce a set of input models for fusing information from ensembles of wearable sensors supporting human performance and telemedicine. Veracity is demonstrated in action classification related to sport, specifically strikes in boxing and taekwondo. Four input models, formulated to be compatible with a broad range of classifiers, are introduced and two diverse classifiers, dynamic time warping (DTW) and convolutional neural networks (CNNs) are implemented in conjunction with the input models. Seven classification models fusing information at the input-level, output-level, and a combination of both are formulated. Action classification for 18 boxing punches and 24 taekwondo kicks demonstrate our fusion classifiers outperform the best DTW and CNN uni-axial classifiers. Furthermore, although DTW is ostensibly an ideal choice for human movements experiencing non-linear variations, our results demonstrate deep learning fusion classifiers outperform DTW. This is a novel finding given that CNNs are normally designed for multi-dimensional data and do not specifically compensate for non-linear variations within signal classes. The generalized formulation enables subject-specific movement classification in a feature-blind fashion with trivial computational expense for trained CNNs. A commercial boxing system, ‘Corner’, has been produced for real-world mass-market use based on this investigation providing a basis for future telemedicine translation

Effects of substance P on mesenteric lymphatic contractility in the rat

Substance P (SP) is associated with lymphatic tissue and is a putative mediator of inflammation. The lymph pump is one of the major "safety factors" preventing edema and its activity is altered by inflammatory mediators. The impact of SP on lymphatics was studied in the rat mesentery. METHODS AND RESULTS: Rats were prepared for in situ lymphatic observation using intravital videomicroscopic techniques. Sections of the small intestine and mesentery were exteriorized and superfused. Lymphatic diameters were measured and pumping activity was determined from the lymphatic diameter tracing. Lymph pump parameters evaluated included diastolic diameter, systolic diameter, contraction frequency, stroke volume, and lymph pump flow. After a control period, the tissues were exposed to SP (10(-9), 10(-8), 10(-7), 10(-6) M). SP reduced both diameters and increased contraction frequency in a concentration-dependent manner. SP (1.0 microM) produced the following changes (% of control): reductions in diastolic diameter (50%), systolic diameter (55%), and stroke volume (63%); a large increase in contraction frequency (661%); and a modest increase in lymph pump flow (44%). SP also stimulated vessels that were not contracting phasically to develop typical contraction patterns. CONCLUSIONS: Although SP produced a tonic constriction of the lymphatics, lymph pump flow was maintained or slightly elevated via an increase in contraction frequency. SP also induced pumping activity in lymphatics that were previously quiescent, thereby further stimulating flow. These effects may serve to minimize the formation of edema in face of the inflammatory edemagenic conditions produced by SP

Thapsigargin inhibits the response to acetylcholine and substance P but does not interfere with the responses to endothelium-independent agents.

We investigated the influence of the Ca(2+)-ATPase inhibitor thapsigargin (TG) on the vasorelaxant response to different endothelium-dependent and endothelium-independent relaxing agents in an isolated thoracic aorta preparation of the rabbit, precontracted by norepinephrine (NE). Pretreatment with 100 microM L-arginine methyl ester (L-NAME) an inhibitor of nitric oxide (NO) synthesis, completely prevented acetylcholine (ACh)-induced relaxation; the inactive stereoisomer D-NAME did not modify the effect of ACh. The exposure of the preparations to 1 microM TG induced a slowly developing slight increase in the basal tension during 30-min contact. The same concentration of TG also slightly reduced the response to the subsequent administration of NE. The antagonist effect of TG on the ACh response was concentration dependent in the range between 0.1 and 10 microM. A 30-min pretreatment with 1 microM TG appeared to be sufficient to induce a consistent antagonism of the ACh (0.01-10 microM) concentration-relaxant effect curve, since an increase to 60 min did not produce a further significant increment in the degree of the antagonist effect. The concentration-dependent relaxation induced by substance P (SP 0.1-3 nM) was also significantly antagonized by 1 microM TG. The effect of the calcium ionophore A23187 (0.01-1 microM) was reduced by the Ca(2+)-ATPase inhibitor only at the higher concentrations tested (0.3-1 microM). However, a 30-min contact time with 1 microM TG was completely ineffective in antagonizing the concentration-relaxant response curves to the two nitrovasodilators sodium nitroprusside (SNP 0.1-100 microM) and nitroglycerin (NTG 1-300 nM) and to the cyclic GMP analogue 8-Bromo-cyclic GMP (3-100 microM). The effects of the beta-adrenoceptor agonist isoprenaline (ISO 0.1-10 microM) and of the direct adenylate cyclase activator forskolin (FK 0.01-10 microM) were also completely unaffected by 1 microM TG. These results demonstrate that TG affects the response to agents that induce an endothelium-dependent relaxation through receptor-dependent calcium mobilization. However, they do not support the hypothesis that sarcoplasmic pump activity is essential for the development of a vasorelaxant response to endothelium-independent agents